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https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/09000/Importance_of_Stem_Cell_Transplantation_in_Cleft.21.aspx
Cleft lip and palate is a congenital malformation that requires a multidisciplinary treatment that evolves pediatrician, obstetrics, fetal medicine, genetics, plastic surgery, orthodontics, speech therapist, nursery, and psychology. Actually, the authors believe that it could be possible to ad protocols to use stem cells.
The intrauterine diagnosis leads to preborn parental orientation and better parental collaboration to accept a precocious multidisciplinary treatment. After birth the authors’ protocol is: orthodontic devices, phonoaudiology, and surgical procedures.
The authors’ cleft lip and palate reconstructive surgery protocol demands several steps and begins at 4 to 6-month old with rhinocheiloplasty and soft palate closure at the same moment. The treatment sequence involves the hard palate surgery (8–18 months after the first surgical step), alveoloplasty (after 10 years old), and secondary rhinoplasty (after 14 years old).
New ideas to use stem cells and blood from the umbilical cord and also blood from placenta are discussed to improve final surgical results. Maternal stem cells are easy to collect, there are no damage to the patient and mother, it is autologous and it could be very useful in the authors’ protocol.
Nine patients with clef lip and palate were operated and had stem cells from umbilical cord blood and placenta blood injected into the bone and soft tissue during the primary procedure (rhinocheiloplasty).
The stem cells activity into soft tissue and bone were evaluated. Preliminary results have shown no adverse results and improvement at the inflammatory response. A treatment protocol with stem cells was developed. It had a long time follow-up of 10 years.]]>Sat, 01 Sep 2018 00:00:00 GMT-05:0000001665-201809000-00021https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/05000/Treatment_of_Mandibular_Ameloblastoma_Involving.107.aspx
Aim:
To describe the treatment of ameloblastoma involving the mandibular body and condyle in 3 patients.
Methods:
This report describes 3 patients with large ameloblastomas (2 were second recurrences) treated by partial mandibular resection. Involvement of the mandibular condyle in these 3 patients made the reconstruction more challenging. Reconstruction included immediate temporomandibular joint replacement by a custom-made alloplastic total joint and mandibular body (Zimmer-Biomet, Jacksonville, FL). These devices were designed using virtual surgical planning software. The 3 patients underwent concomitant bone graft reconstruction using autogenous-free corticocancellous block bone grafts from the iliac crest. This facilitated later dental implant placement and full dental rehabilitation. Direct inferior alveolar nerve repair or nerve graft reconstruction with allograft was also carried out for all 3 patients. Maxillomandibular fixation was not used in all 3 patients.
Results:
All the 3 patients underwent successful surgery and recovery. Mandibular function was preserved. The concomitant bone graft allowed successful dental implant placement for subsequent planned restorative dentistry.
Conclusion:
Ameloblastoma involving the mandibular condyle can be successfully treated by resection and concomitant total joint replacement with an alloplastic device. This technique shows promise in that there is rapid return to excellent function thanks to rigid fixation of the construct. Mirroring software used in the prosthesis design facilitates excellent cosmetic outcomes.]]>Tue, 01 May 2018 00:00:00 GMT-05:0000001665-201805000-00107https://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/10000/Patients_With_Lower_Eyelid_Orbital_Fat_Hyperplasia.35.aspx
Purpose:
Lower eyelid orbital fat hyperplasia has not been described in young age patients.
Methods:
A fourteen-year-old girl, a 29-year-old man, and 42-year-old man had visited our hospital complaining of a lower eyelid bulge. In orbital computed tomography examination, there was excess fat tissue compared with the opposite side, but no mass lesion matched with the area of lower eyelid bulge in our patients. The authors planned surgery for the removal of excess fat through the conjunctival incision. Intraoperatively, there was no real fat herniation through the septum. Septum continuity was maintained and thinning or distention of the orbital septum was not observed in our patients. The authors opened the orbital septum and removed the excess fat to make symmetry bilaterally. In the pathologic examination, removed fat tissue is not different with normal fat tissue.
Conclusions:
The authors reported these findings at the first time. So they proposed the patient's condition as “lower eyelid orbital fat hyperplasia.”]]>Thu, 01 Oct 2015 00:00:00 GMT-05:0000001665-201510000-00035https://journals.lww.com/jcraniofacialsurgery/Fulltext/2016/09000/Analysis_of_Fractured_Mandible_Over_Two_Decades.17.aspx
Abstract
Mandible fractures have a special place within the injuries of the other bones of the maxillofacial system. In their management, cosmetic issues and functional aspects such as chewing, speaking, and swallowing become very important.
In this study, a retrospective analysis of 419 mandible fractures in 283 patients was performed in relation to epidemiologic factors, treatment strategies, and complications. The average age was 32.14 years (4–69 years). The male/female ratio was 4/1. The most frequent etiologic factor was interpersonal violence (104 patients, 36.7%). The parasymphysis region was the mostly affected site (28.4%). A total of 157 patients (55.5%) were presented with single fracture and the rest with 2, 3, or 4 fracture lines on the mandible. The most common fracture combination was angulus–parasymphysis fracture combination (24.6%). Open reduction and fixation with mini plates and screws was the most preferred treatment strategy (48.2%). Transient short arch bars were not used intraoperatively for any of the patients. There was not any difference in terms of complications between the patients treated with plating systems and plating systems plus intermaxillary fixation.
In conclusion, proper treatment of mandible fractures is critical. Except certain fracture types, the usage of intermaxillary fixation as an adjunct to fixation with plating systems is not necessary.]]>Thu, 01 Sep 2016 00:00:00 GMT-05:0000001665-201609000-00017https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/10000/A_Simple_and_Reliable_Submental_Intubation.68.aspx
In 1986, Altemir first reported the use of submental intubation to avoid tracheotomy in patients with panfacial and midfacial fractures for whom intermaxillary fixation is necessary, but orotracheal and nasotracheal intubations are not recommended. This novel technique allowed intraoperative access to perform dental occlusion and reconstruction of the nasal pyramid in patients with skull base fractures. Herein, we describe a refined technique based on Altemir's original procedure. Seven male patients with panfacial fractures underwent submental intubation using our refined technique. The technique was developed after encountering a technical error with Altemir's original procedure. In this new technique, we employed a 2-0 silk suture guide to allow the passage of both the endotracheal and cuff-inflation tubes through the same tunnel created from the oral cavity to the submental area. The success rate of the refined technique was 100%, and there were no intraoperative or postoperative complications. There was 20 seconds of ventilation outage time in total. Endotracheal and cuff-inflation tubes were easily and quickly passed through the same submental tunnel. Our refined technique is simple, easy, safe, fast, inexpensive, and does not require specific materials. Submental scars were smaller and relatively inconspicuous in this study, compared to those reportedly associated with other modified techniques.]]>Mon, 01 Oct 2018 00:00:00 GMT-05:0000001665-201810000-00068https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/10000/The_Promising_Effects_of_Transplanted_Umbilical.8.aspx
Many studies have reported the recovery ability of umbilical cord-derived mesenchymal stem cells (UC-MSCs) for neural diseases. In this study, the authors explored the roles of UC-MSCs to treat the traumatic brain injury. Umbilical cord-derived mesenchymal stem cells were isolated from healthy neonatal rat umbilical cord immediately after delivery. The traumatic brain injury (TBI) model was formed by the classical gravity method. The authors detected the behavior changes and measured the levels of inflammatory factors, such as interleukin-lβ and tumor necrosis factor-α by enzyme linked immunosorbent assay (ELISA) at 1, 2, 3, 4 weeks after transplantation between TBI treated and untreated with UC-MSCs. Simultaneously, the expression of glial cell line-derived neurotrophic factor (GDNF) and brain derived neurotrophic factor (BDNF) were measured by real-time–polymerase chain reaction and ELISA.
The authors found that the group of transplantation UC-MSCs has a significant improvement than other group treated by phosphate buffered saline. In the behavioral test, the Neurological Severity Scores of UC-MSCs + TBI group were lower than TBI group (P Mon, 01 Oct 2018 00:00:00 GMT-05:0000001665-201810000-00008https://journals.lww.com/jcraniofacialsurgery/Fulltext/2014/07000/The_Efficacy_and_Safety_of_Microvascular.63.aspx
Objective
The aim of this study was to review the efficacy and safety of microvascular decompression (MVD) for idiopathic trigeminal neuralgia (ITN) in elderly patients older than 65 years.
Methods
From June 2006 to June 2011, a total of 59 elderly patients with ITN underwent MVD. We performed a retrospective study of the medical records and compared the outcome data with those from 164 patients younger than 64 years during the same period.
Results
The mean age of the elderly and younger patient groups was 72 and 55 years. The pain was completely relieved in 93.2% and partially relieved in another 5.1% of the elderly patient group after surgery. The mean follow-up period was 42 months (range, 16–75 mo). A total of 8.9% of the patients in the elderly patient group experienced recurrence. Headaches, nausea, and vomiting were more frequent complications. There were no mortalities and severe morbidities after surgery. Between the elderly and younger patient groups, no statistically significant differences existed in the outcomes.
Conclusions
Microvascular decompression is a safe and effective procedure for elderly patients with ITN. It is recommended that any patients with ITN should have the opportunity to choose MVD, unless their condition cannot tolerate general anesthesia.]]>Tue, 01 Jul 2014 00:00:00 GMT-05:0000001665-201407000-00063https://journals.lww.com/jcraniofacialsurgery/Fulltext/2017/01000/Midface_Advancement_in_a_Simple_Approach.25.aspx
Background:
Midface advancement is a keystone intervention in the treatment plan of syndromic hypoplasia of the midface. Although earlier authors had been using a combination of smaller incisions to acquire enough access to perform the different osteotomies, Tessier popularized the bicoronal incision. This approach can be time-consuming however and leaves an ear-to-ear scar. The authors describe an endoscopically assisted piezo-electric Le Fort III osteotomy performed through minimal invasive access. The cutaneous incision was limited to a single-short mid-glabellar vertical scar (8 mm) to perform the nasofrontal and septum osteotomy. Further osteotomies are performed through a 1.5 cm intraoral incision and a transconjunctival approach with a retrocaruncular extension. A lateral canthotomy was avoided to lower the risk of postoperative eyelid malposition.
Methods:
A feasibility study using 2 fresh nonfrozen cadaver heads.
Conclusion:
The minimally invasive Le Fort III approach is feasible and efficacious for clinical use in a cadaveric setup.]]>Sun, 01 Jan 2017 00:00:00 GMT-06:0000001665-201701000-00025https://journals.lww.com/jcraniofacialsurgery/Fulltext/2005/09000/Laser_Treatment_of_Congenital_Nevi.34.aspx
Congenital nevi are benign proliferations present at birth that consist of cells normally present in the skin. Many of these lesions are disfiguring and a source of psychosocial impairment. Because of location or extent of the lesion, surgical excision of the nevus may leave a defect without favorable reconstructive options. Laser ablation of such lesions has been used by several clinicians. A review of laser terminology is presented along with a review of nevus of Ota, nevus of Ito, café-au-lait macules, lentigines, and congenital melanocytic nevi. Although good results may be achieved with laser ablation of these lesions, laser treatment modalities for congenital melanocytic nevi remain controversial because of the potential for malignancy.]]>Thu, 01 Sep 2005 00:00:00 GMT-05:0000001665-200509000-00034https://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/09000/Guideline_for_Care_of_Patients_With_the_Diagnoses.3.aspx
No abstract available]]>Tue, 01 Sep 2015 00:00:00 GMT-05:0000001665-201509000-00003https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/11000/An_Honorable_Scar_on_the_Face___A_Scar_Worthy_of.3.aspx
No abstract available]]>Thu, 01 Nov 2018 00:00:00 GMT-05:0000001665-201811000-00003https://journals.lww.com/jcraniofacialsurgery/Fulltext/2005/09000/Producing_Accurate_Platelet_Counts_for_Platelet.4.aspx
Platelet rich plasma (PRP) has been shown to clinically accelerate healing of both soft and hard tissues. As a result, it has gained increasing popularity. However, the clinical effectiveness of each type of PRP preparation method can vary in technique and efficiency, and current methods to evaluate the platelet concentration efficiency of PRP systems have several limitations. Therefore, the purpose of this study was to validate an automated hematology analyzer, the Cell-Dyn 3700, to accurately count platelets in concentration ranges of approximately 2,000,000-4,800,000 platelets/μL. PRP platelets were counted by way of a manual counting method and on the Cell-Dyn 3700, and the statistical evaluation indicated no difference between the groups (P > 0.05). Dilution of the PRP was not required, and accurate platelet counts could be achieved up to platelet concentrations of 4,800,000 platelets/μL. PRPs must be resuspended on a rocker for at least 5 minutes before platelet counts, and the entire PRP sample must be resuspended to allow for equal distribution of platelets before counting. With use of the validated Cell-Dyn 3700, a platelet concentrate system was used to prepare 153 PRPs. The baseline whole blood platelet concentration (328,000 platelets/μL ± 69,000 platelets/μL) and the average PRP samples (2,645,000 platelets/μL ± 680,000 platelets/μL) were compared, resulting in an eightfold increase in concentration and an average platelet percent recovery of approximately 76%. Automated hematology analyzers can be used to accurately count platelets in PRP given the system has been validated appropriately and the PRP samples are prepared properly to provide adequate platelet suspension.]]>Thu, 01 Sep 2005 00:00:00 GMT-05:0000001665-200509000-00004https://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/06000/Postoperative_Low_Flow_Cerebrospinal_Fluid_Leak_of.67.aspx
Abstract
To assess the effectiveness of continuous lumbar drainage (LD) for management of postoperative cerebrospinal fluid leaks after endoscopic endonasal transsphenoidal approach for resection of pituitary adenoma.
Three hundred eighty-four medical records of patients who were admitted to our institute during a 2.5-year period were retrospectively reviewed, 33 of them experienced low-flow cerebrospinal fluid leak postoperatively. If LD was used, all patients with low-flow cerebrospinal fluid leak were classified into 2 groups, lumbar drained group and conservatively treated group. The age, sex, management of cerebrospinal fluid leaks, and related complications were reviewed. Statistical comparisons between the 2 groups were made using SPSS 19.0 (IBM Corp, Armonk, NY). The differences were considered statistically significant if the P value was less than 0.05.
Thirty-three of 384 (8.6%) experienced low-flow postoperative cerebrospinal fluid leaks. Cured rate of cerebrospinal fluid leak was 94.4% (17/18) in continuous lumbar drained group, and 93.3% (14/15) in control group. There were 2 (11.2%) patients who developed meningitis in the LD group and 1 (5.6%) patient in the control group. One patient required endoscopic repair of skull base because of persistent cerebrospinal fluid leak in both groups, with the rates of 5.6% and 6.7%, respectively. There was no significant difference noted in each rate in both groups.
Placement of LD may not be necessary for the management of low-flow postoperative cerebrospinal fluid leak after using endoscopic endonasal transsphenoidal approach to pituitary adenoma.]]>Mon, 01 Jun 2015 00:00:00 GMT-05:0000001665-201506000-00067https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/09000/Le_Fort_II_Osteotomy_and_Modified_Technique.12.aspx
Introduction:
The LeFort II osteotomy has a specific number of indications, thus this is true, there is less experience with the technique. The authors present a modification to the technique and extensive step-by-step procedure explanation in order to share their experience for making a safe surgery.
Material and Methods:
A clinical report is presented of a nonsyndromatic patient with nasomaxillary hypoplasia, in which the authors make an LeFort II osteotomy with circumvestibular, transcaruncular, and “W”-shaped approaches, with minimal scar showing, in order to offer better aesthetic outcomes as well as functional and skeletal.
Results:
Patient presenting with an optimal postoperative clinical and skeletal results. Cephalometic measurments in normal ranges. Obtaining during the process of the surgery, description the surgery, and potential complications.
Conclusion:
Using the Le Fort II osteotomy in nonsyndromic nasomaxillary hypoplasia is a helpful and left away technique, because of its complexity. The authors give a step-by-step detailed description of the surgical technique with perioperative management. In summary, the steps provided give unique information about this reproducible and aesthetic technique.]]>Sat, 01 Sep 2018 00:00:00 GMT-05:0000001665-201809000-00012https://journals.lww.com/jcraniofacialsurgery/Fulltext/2014/01000/Treatment_Strategy_in_Goldenhar_Syndrome.38.aspx
Abstract
Goldenhar syndrome is a rare congenital defect characterized by ocular symptoms including (epibulbar dermoids, microphthalmia, anophthalmia, eyes asymmetry/dysmorphy, cleft eyelid, exophthalmia, strabismus), auricular symptoms (dacryocystitis), preauricular appendages, preauricular fistulas, ear asymmetry, microtia, atresia of the external auditory canal), craniofacial deformities (cleft face, cleft lip, cleft palate, macrostomia, bifid tongue, hypoplasia of the mandible, hypoplasia of the maxilla, asymmetry of the mandible and maxilla, malocclusion, tooth discrepancies, agenesis of third molars and second premolars, supernumerary teeth, enamel and dentin malformations, delay in tooth development), and skeletal abnormalities (cleft spine, microcephaly, dolichocephaly, plagiocephaly, vertebral defects) or abnormalities of internal organs. The degree of abnormalities vary from severe to mild. In this article, we present a long-term observation of a patient with Goldenhar syndrome. During the patient’s life, the intensification of anomalies varied. We describe preoperative and postoperative orthodontic treatment and surgical correction procedures of maxillofacial deformation.]]>Wed, 01 Jan 2014 00:00:00 GMT-06:0000001665-201401000-00038https://journals.lww.com/jcraniofacialsurgery/Fulltext/2009/01000/Maternal_Reports_of_Satisfaction_With_Care_and.37.aspx
Craniosynostosis is a congenital deformity caused by premature fusion of cranial suture(s). Surgical outcomes of craniosynostosis have been well documented; however, limited published data are available regarding access to care and social and psychological health outcomes for children with craniosynostosis. The authors conducted a population-based, multistate study of maternal perceptions of care and outcomes for children with craniosynostosis born from January 1998 through December 2003. Mothers of 147 children were contacted and asked to complete a structured telephone interview; 82 mothers (55.8%) participated. Overall, the mean ages of children and their mothers at the time of interview were 4.4 and 34.8 years, respectively. Mothers interviewed tended to be white and, at a minimum, high school graduates. Most mothers reported being satisfied with the craniosynostosis-related information and support provided by medical care providers, and access to primary and specialty care was most often rated as satisfactory. Mothers tended to report the physical health of their child to be good; however, delays in cognitive and emotional development, hearing loss, and speech problems were identified. In addition, statistically significant differences among mothers in each state were noted for reports of the quality of team care, primary care, learning interventions, and perceived need for additional surgeries. These results suggest some limitations in craniosynostosis-related care and provide guidance to medical and surgical care providers in making need-based improvements in craniosynostosis surgery and care. Future studies are recommended to replicate this evaluation in additional populations.]]>Thu, 01 Jan 2009 00:00:00 GMT-06:0000001665-200901000-00037https://journals.lww.com/jcraniofacialsurgery/Fulltext/2008/11000/Pott_s_Puffy_Tumor.58.aspx
Pott's Puffy tumor is a rare clinical entity characterized by subperiosteal abscess associated with osteomyelitis. It is usually seen as a complication of frontal sinusitis or trauma predominantly in the adolescent age group. Pott's Puffy tumor can be associated with cortical vein thrombosis, epidural abscess, subdural empyema, and brain abscess. The cause of vein thrombosis is explained by venous derange of the frontal sinus, which occurs through diplopic veins, which communicate with the dural venous plexus; septic thrombi can potentially evolve from foci within the frontal sinus and propagate through this venous system. An apparently healthy 7-year-old girl presented to the emergency service of otolaryngology with complaints of swelling of forehead and periorbital zone, headache, chills, fever, and rhinorrhea. The patient described in this case report had 2 important complications of paranasal sinus disease: the relatively common complication of postseptal cellulites and the less common complication of Pott's Puffy tumor.]]>Sat, 01 Nov 2008 00:00:00 GMT-05:0000001665-200811000-00058https://journals.lww.com/jcraniofacialsurgery/Fulltext/2014/11000/Attachment_Rate_of_the_Inferior_Alveolar_Nerve_to.42.aspx
Abstract
This study was aimed to investigate a modified buccal osteotomy technique and whether the integrity of the lingual part of the lower border influences the attachment of the neurovascular bundle to the proximal segment of the mandible during a sagittal split osteotomy without increasing the number of bad splits. The presence of self-reported sensibility disturbance in the lower lip at the last follow-up visit was assessed. This study included 220 and 133 patients with bilateral sagittal split osteotomy undergoing the classical and the new modified buccal osteotomy techniques, respectively. In the new technique, the lower border is divided into a lingual fragment that remains incorporated in the tooth-bearing fragment and a buccal fragment that comes with the proximal fragment (buccal plate). In the classical technique, the inferior alveolar nerve was attached to the proximal segment of the mandible in more than one third of operation sites (36.36% on the right and 40.91% on the left) compared with less than one fourth of the operation sites using the new technique (9.73% on the right and 23.01% on the left). The overall figure of self-reported changed sensibility was 09.40% (12/128) in the new technique compared to 15.12% in the classical technique. We present a suitable improvement to the classical buccal osteotomy technique that allows less manipulation and injury of the inferior alveolar nerve with consequent reduction in self-reported postoperative changes in lower lip sensation.]]>Sat, 01 Nov 2014 00:00:00 GMT-05:0000001665-201411000-00042https://journals.lww.com/jcraniofacialsurgery/Fulltext/2011/05000/Numerical_Survey_of_the_Different_Shapes_of_the.82.aspx
Experimental results are reported for the numerical quantities of the different shapes of human nose where, to the best of the author's knowledge, this approach has never been applied. The results are based on 1793 pictures of noses, of which 403 are artworks, 498 are photographs taken by the author in Europe-Holland, Belgium, and France-while visiting these places, 801 were photographed in Israel, and 91 are not clear where exactly photographed. One thousand eighty-one were photographs of men, and 712 were of women. The author has succeeded to classify all the noses into 14 groups, where for each nose shape it was possible to find also an artistic demonstration. Near each shape the percentage of the total number of noses of a certain nose shape is reported. The detailed results for the number of noses versus their shape and sources: artworks and photographing places-Europe and Israel-are reported. The most widespread nose, 24.2%, is shape 1, the fleshy nose, where the least widespread nose, 0.45%, is shape 4. It should be emphasized also that shape 14, 0.05%, photographed in Israel is extremely unique and the only one existing among the 1793 noses that were considered.]]>Sun, 01 May 2011 00:00:00 GMT-05:0000001665-201105000-00082https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/11000/Three_Dimensional_Analysis_of_the_Correlation.11.aspx
Background:
The prime aims of this study were to establish cephalometric linear and angular normative values of the lower face using a three-dimensional (3D) analysis in Korean individuals, and validate whether the linear and angular measurements using 3D laser scanner are comparable with measurements using 3D computed tomography (CT).
Methods:
In this study, 40 Korean individuals aged between 18 and 60 years were enrolled. Using 3D CT scan and 3D laser scanner, linear and angular values of the lower face were measured and recorded. Statistical analysis was carried out to verify the concordance and correlation between two 3D imaging modalities.
Results:
The 40 samples consisted of 11 women with a mean age of 40.8 ± 14.5 years and 29 men with a mean age of 29.7 ± 15.0 years. The results demonstrated the difference between sex and the tendency of asymmetry on both sides. Among different methods of measuring angular values, the gonial angle (GA) between tragion’ (Tr’)-gonion’ (Go’)-menton’ (Me’) from 3D laser scanning and between articulate-gonion-menton from CT scan demonstrated a good concordance and a high correlation.
Conclusions:
The GA measured between Tr’-Go’-Me’ using a 3D facial laser scan was comparable with values from 3D CT scan. The reference points and the GA, which we assessed here for 3D laser scanning, can be a reliable alternative method evaluating mandibular angles for assessing patients and surgical planning in plastic and orthognathic surgery.]]>Thu, 01 Nov 2018 00:00:00 GMT-05:0000001665-201811000-00011https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/11000/Anthropometric_Evaluation_of_Periorbital_Region.5.aspx
Introduction:
Direct anthropometric and three-dimensional (3D) photogrammetry measurements have been used extensively in cleft/craniofacial surgery to assess morphological changes and surgical outcomes. Craniofacial procedures alter the sagittal projection of periorbital bony prominences. Mulliken described a method of measuring their projection relative to the corneal plane but is impractical in clinical practice. Three-dimensional photogrammetry may offer a solution; however, the cornea is not visualized on this. The authors propose to develop new normative measurements of facial projection relative to the pupil.
Methods:
Five 3D photographs were taken of 5 individuals using Vectra M5 camera. Facial projection measurements were taken of the sagittal projection of the bilateral periorbital landmarks and nasal radix relative to the pupil using Mirror 3D analysis. Standard deviations (SD) were determined for each subject and laterality. Chi-square tests confirmed all SD <1 mm. Intra and inter-rater reliability were confirmed with an intraclass correlation coefficient assessment.
Results:
Three male and 2 female subjects were photographed with 5 unique images. Standard deviations of repeat measures of all landmarks were <0.5 mm. Chi-square tests confirmed with statistical significance that SD for all values except for the radix was <1 mm (P<0.05). Intrarater reliability was high for all landmarks (intraclass correlation coefficient coefficients 0.93–0.99). Inter-rater reliability was good for the lateral canthi and excellent for all others.
Conclusion:
This technique demonstrates repeatability with high reliability on serial photographs and is applicable to measuring surgery effects and growth on facial projection. Establishment of age-specific normative values for landmark projection will refine usage applicability in operative planning.]]>Thu, 01 Nov 2018 00:00:00 GMT-05:0000001665-201811000-00005https://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/09000/Endonasal_Endoscopic_Transsphenoidal_Approach_to.6.aspx
Objective:
Endoscopic endonasal (transnasal) transsphenoidal approach (EETA) for management of sellar lesions has gained popularity as a reliable and atraumatic method. Most reported studies of EETA have focused on surgical outcome in adult patients; and there are few reports to describe outcome in pediatric patients. The authors report our early experience of 11 patients aged 14 to 18 years managed with EETA to evaluate the safety and effectiveness of EETA in the pediatric.
Methods:
Retrospective review of hospital records of 11 pediatric patients who underwent endonasal endoscopic transsphenoidal approach for resection of sellar region lesion over 2 years. Age, sex, symptoms, tumor size, extent of tumor resection, clinical outcome, and surgical complications were reviewed.
Results:
Total resection was achieved in 9 (81.8%) patients, subtotal resection in 2 (18.2%), and no patient had partial or insufficient resection. All (100%) patients achieved visual remission, 7 (87.5%) of 8 patients with hyperhormone preoperative had endocrinological remission. Two (18.2%) patients incurred temporary diabetes insipidus (DI) postoperatively. One (9.1%) patient incurred postoperative cerebrospinal fluid (CSF) leakage which resolved following lumbar drainage. Three (27.3%) patients developed hypopituitarism needed hormone replacement therapy. There were no cases of meningitis, intracranial hematoma, or death.
Conclusions:
Endoscopic endonasal (transnasal) transsphenoidal approach (EETA) provides a safe and effective surgical option with low morbidity and mortality in pediatric patients.]]>Tue, 01 Sep 2015 00:00:00 GMT-05:0000001665-201509000-00006https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/10000/Persistent_Opioid_Use_Among_Children,_Adolescents,.10.aspx
Background:
Surgical care represents an important source of opioid prescribing and chronic use, but rates of prolonged opioid use following pediatric procedures remain unclear. The authors describe the rates and risk factors for new persistent opioid use in patients after common cleft operations.
Methods:
The authors examined claims from the Truven Marketscan databases from January 1, 2010 to December 31, 2014. The authors included opioid-naive patients ages 8 to 25, who underwent 1 of 10 cleft-related procedures. Patients were considered opioid-naïve if they had no opioid prescription fills in the 11 months prior to the perioperative period. The authors obtained a random sample of age-matched, nonsurgical patients from the same dataset to be used as a control group. Included cleft patients had no procedural codes in the 6 months following surgery. All included patients filled an opioid prescription during the perioperative period, defined as 30 days before and 14 days after surgery. The primary outcome was new persistent opioid use, which is defined as continued opioid prescription fills between 90 and 180 days after the procedure.
Results:
This cohort included 2039 cleft patients and 2100 control patients. The incidence of new persistent opioid use following surgery was 4.4% and 0.1% in the control group. Higher odds of opioid use 3 months beyond surgery were associated with distractor placement (OR 5.34, CI 2.00–14.24, P = 0.001). Increasing age (OR 1.11, CI 1.04–1.17, P = 0.001) and presence of a gastrointestinal comorbidity (OR 7.37, CI 1.49–36.54, P = 0.014) were also associated with new persistent use.
Conclusions:
New persistent opioid use occurs after cleft-related procedures and could lead to chronic use in children, adolescents, and young adults.]]>Mon, 01 Oct 2018 00:00:00 GMT-05:0000001665-201810000-00010https://journals.lww.com/jcraniofacialsurgery/Fulltext/2005/09000/Congenital_Lip_Pits_and_Van_der_Woude_Syndrome.38.aspx
Van der Woude syndrome is an autosomal dominant disease characterized by lower lip pits with or without cleft lip and/or cleft palate. The lip pits commonly have salivary glands that drain into them, which leads to salivary flow from the lip pits. Lip pits may be associated with submucosal palatal cleft, velopharyngeal insufficiency, or genitourinary or cardiovascular anomalies. The pits are treated by surgical resection. The authors report a case of van der Woude syndrome with isolated lip pits and speech difficulties that had been unrecognized until the patient was 6 years old. The surgical technique is described to ensure that the often-bifurcating tracts are removed entirely.]]>Thu, 01 Sep 2005 00:00:00 GMT-05:0000001665-200509000-00038https://journals.lww.com/jcraniofacialsurgery/Fulltext/2004/11000/Intra__and_Perioperative_Complications_of_the.16.aspx
The LeFort I osteotomy has become a routine procedure in elective orthognathic surgery. The authors report the occurrence of intra- or perioperative complications in a series of 1000 consecutive LeFort I osteotomies performed within a 20-year period. In total, 64 (6.4%) patients experienced complications. Anatomical complications affected 26 (2.6%), patients, including 16 (1.6%) with a deviation of the nasal septum and 10 (1.0%) with non-union of the osteotomy gap. Extensive bleeding that required blood transfusion occurred in 11 (1.1%) patients exclusively after bimaxillary corrections; in 1 patient a ligation of the external carotid artery became necessary. Significant infections such as abscesses or maxillary sinusitis occurred in 11 (1.1%) patients. No patient experienced an osteomyelitis. Ischemic complications affected 10 (1.0%) patients, including 2 (0.2%) who experienced an aseptic necrosis of the alveolar process and 8 (0.8%) who, under critical revision, were affected by retractions of the gingiva. Five (0.5%) patients experienced an insufficient fixation of the osteosynthesis material. The risk and the extent of complications was enhanced in patients with anatomical irregularities (eg, in patients with craniofacial dysplasias, orofacial clefts, or vascular anomalies). The risk of ischemic complications was enhanced in extensive dislocations or transversal segmentation of the maxilla. The authors conclude that patients with major anatomical irregularities should be informed about an enhanced risk of Le-Fort I osteotomies. Preoperative planning avoiding transversal segmentation or extensive dislocations of the maxilla should reduce the occurrence of complications. For healthy individuals, the risk of complications with the LeFort I osteotomy is considered low.]]>Mon, 01 Nov 2004 00:00:00 GMT-06:0000001665-200411000-00016https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/11000/The_Arterialized_Facial_Artery_Musculo_Mucosal.6.aspx
Background:
In 1992, Pribaz described the facial artery musculomucosal flap (FAMM), an axial musculomucosal flap based on the facial artery. The FAMM flap, a modification of the nasolabial and buccal mucosal flaps, is widely used in the reconstruction of defects in the oral cavity. Many modifications of this flap have been described in the literature. Here we aimed to explore the use of an arterialized tunnelized FAMM island flap (a-FAMMIF) for the reconstruction tongue defects after tumor resection.
Method:
From January 2015 to December 2016, five cases of tongue cancer were selected for the use of arterialized FAMMIF flap to reconstruct defects after tumor resection.
Results:
Reconstruction was successful in all cases, except one case of total flap necrosis; partial necrosis of the flap occurred in two patients, which were solved with medications.
Conclusion:
The authors consider the a-FAMMIF an unreliable flap in the reconstruction of tongue defects.
The authors recommend avoiding tunneling and island modification when the vein is not included in the pedicle.]]>Thu, 01 Nov 2018 00:00:00 GMT-05:0000001665-201811000-00006https://journals.lww.com/jcraniofacialsurgery/Fulltext/2017/01000/Orbital_Morphometry___A_Computed_Tomography.101.aspx
Introduction:
The human orbit is a complex anatomic region, which plays predominant role in the evaluation of craniofacial complex. A thorough understanding of the relationship of the distance from orbital rim to the important vital structures of the orbital apex is required for the surgeon to perform safe and effective surgery.
Objectives:
To evaluate and compare the depth and distances from various points of the orbital rim to the fissures and foramina of the orbital apex between genders in the local population.
Methodology:
Linear measurements were conducted on 60 orbits from 30 patients who had undergone head computed tomography scan. These measurements were done utilizing the multiplanar reconstruction modes on computed tomography images with minimum slice thickness of 1 mm.
Results:
Males have statistically significant larger orbits than females with higher mean measurements in all parameters, except for the distance from posterior ethmoidal foramen to the optic canal which was the same. However, there were no significant differences in all parameters between the right and left orbits.
Conclusion:
This study provides the absolute limit of safe internal orbital dissection in respect to the local population. Despite males having larger orbits than females, it is clinically negligible.]]>Sun, 01 Jan 2017 00:00:00 GMT-06:0000001665-201701000-00101https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/09000/Vomer_Flap___A_Golden_Tool_for_the_Treatment_of.108.aspx
Despite the lack of consensus regarding the treatment of labio-palatal clefts, each treatment protocol is the expression of an individual perspective that accumulates the experience of each multidisciplinary group, which all pursue the same goal: to achieve adequate language development with the lowest possible impact on facial growth. To achieve this, a management scheme has been developed, this exploits vomer flaps for the closure of palatal clefts and limits dissections in the palatine segments. Modifications are presented in the design and dissection of vomer flaps, so as to use the largest amount of mucosal tissue available, thus facilitating closure of the different clefts, particularly in Veau Group III clefts.]]>Sat, 01 Sep 2018 00:00:00 GMT-05:0000001665-201809000-00108https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/11000/Genomic_Surgery___Through_the_Translational.2.aspx
No abstract available]]>Thu, 01 Nov 2018 00:00:00 GMT-05:0000001665-201811000-00002https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/11000/The_Accuracy_of_Cone_Beam_Computed_Tomography_for.7.aspx
The aim of this study was to evaluate the accuracy of cone-beam computed tomography (CBCT) for determining cortical thickness and the gray value, investigating its correlation with micro-computed tomography (CT) and histology analysis. Sixty-two bone samples from 4 anatomic regions of the jaw were analyzed. A radiographic surgical stent was used during CBCT and bone sample harvesting. The cortical thickness and gray value of the planned implant were evaluated by CBCT. Bone volumetric fractions, bone mineral density, and % porosity assessed by micro-CT and mineralized material by histology analysis from harvested bone samples were analyzed and assessed for the association with the CBCT using Pearson correlation. A correlation between cortical thickness measured from the CBCT and Micro-CT (r = 0.933, P Thu, 01 Nov 2018 00:00:00 GMT-05:0000001665-201811000-00007https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/11000/A_Giant_Congenital_Soft_Tissue_Sinonasal.23.aspx
Myxomas of the nose are very rare benign neoplasms. They grow slowly, infiltrate the surrounding bone cortex, and develop multiple local recurrences with no distant metastasis. Almost, even knowing seen at any age, it is very rare in newborn. The authors present a patient with sinonasal soft tissue fibromyxoma in a newborn baby nose followed by the literature.]]>Thu, 01 Nov 2018 00:00:00 GMT-05:0000001665-201811000-00023https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/11000/Distraction_Sugosteogenesis___Its_Biologic_Bases.18.aspx
Purpose:
Recently, the terms sugosteogenesis and distraction sugosteogenesis have been introduced to the scientific literature. While the former describes a biologic phenomenon, the latter refers to the clinical technique which relies on the accelerated normal bone healing process that takes place at the osseous walls surrounding a cystic cavity when active negative pressure is applied. The purpose of this study is to provide the biologic bases and the therapeutic principles of this emerging technique. Employing well-stablished biologic principles, clinical evidence from analogous techniques, emerging experimental data, and circumstantial evidence, this study presents the possible mechanism of action of the evacuator for odontogenic cysts (Evocyst), a closed, vacuum-like drain system intended to treat cystic conditions using negative pressure.
Methods:
A review of the literature was done. Keywords for the Medline search were: marsupialization, decompression, odontogenic cysts, effects of negative pressure on bone, and negative pressure wound therapy. In addition, relevant publications from the reference list of the retrieved studies were considered. The matches were evaluated for relevance and analyzed accordingly. Clinical reports used to illustrate the concept of distraction sugosteogenesis were performed following the Declaration of Helsinki on medical protocol and ethics.
Results:
Currently, the standard of care to manage odontogenic cystic lesions includes marsupialization, enucleation and curettage, decompression, and surgical resection. However, there is a need for an alternative option in which the entity could be treated while promoting bone formation. With large odontogenic cystic conditions treated in a short period of time, distraction sugosteogenesis appears to be a choice.
Conclusion:
The application of negative pressure to osseous cells produces a stretching that creates mechanical cues that trigger signaling pathways, promotes fluid flow, and enhances angiogenesis. All of them, combined, may explain sugosteogenesis. The clinical application of such parameters may explain the good clinical results obtained with the Evocyst.]]>Thu, 01 Nov 2018 00:00:00 GMT-05:0000001665-201811000-00018https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/11000/An_Algorithmic_Approach_to_the_Management_of.4.aspx
Annual incidence of non-fatal ballistic civilian has been increasing for the last decade. The aim of the present study was to clarify the optimal reconstructive management of civilian ballistic facial injuries. A systematic review of PubMed was performed. Articles were evaluated for defect type and site, reconstructive modality, complications, and outcomes. A total of 30 articles were included. Most common region of injury was mandibular with a 46.6% incidence rate. All-cause complication rate after reconstruction was 31.0%. About 13.3% of patients developed a postoperative infection. Gunshot wounds had overall lower complication rates as compared with shotgun wounds at 9.0% and 17.0%. By region, complications for gunshot wounds were 35% and 34% for mandible and maxilla, respectively. Immediate surgical intervention with conservative serial debridement is recommended. However, for patients with pre-existing psychiatric disorders, secondary revisions should be delayed until proper psychiatric stabilization. When there is extensive loss of soft tissue in the midface, aesthetic outcomes are achieved with a latissimus dorsi or anterolateral thigh free flap. Radial forearm flap is favored for thin lining defects. Open reduction is suggested for bony-tissue stabilization. The fibula flap is recommended for bony defects >5 cm in both midface and mandible. For bony defects, <5 cm bone grafting was preferred. Delaying bone grafting does not worsen patient outcomes. Surgical treatment of ballistic facial trauma requires thorough preparation and precise planning. An algorithm that summarizes the approach to the main decision points of surgical management and reconstruction after ballistic facial trauma has been presented in this study.]]>Thu, 01 Nov 2018 00:00:00 GMT-05:0000001665-201811000-00004https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/11000/Intracorporeal_Septorhinoplasty___Technique_and.12.aspx
Objective:
Septal deformities usually associated with functional and aesthetic nasal consequences. Multiple techniques were described to correct these deformities. Using less invasive and at the same time competent technique with loge standing results is important. This study aimed to assess intracorporeal correction for septal deviation with assessment of its competence in managing deferent degrees of deviation and to show concomitant patient-dependant internal valve manipulation used.
Methods:
Intracorporeal correction of septal deviation was used in 35 patients which was performed at plastic surgery departments of Menoufia University Hospital and Mawada Privet Hospital, Egypt. The study was carried out between July 2014 and July 2017.
Results:
Thirty-five patients with variable types of septal deformities, 16 of them were females and 19 were males, were included in the study. Age of patients was between 18 and 55 years (mean 24.9, standard deviation 7.9). Etiology was found as follows: 15 (about 43%) posttraumatic septal deviation, 8 (about 23%) patients had postcleft septal deviation, and the remaining 12 had idiopathic septal deviation. Spreader graft was in 22 (about 63%) patients. Septal hematoma followed by septal perforation occurred in 1 patient (2.8%), while dorsal irregularities were found in 3 (8.4%) patients. Recurrent septal deviation occurred in 2 (5.6%) patients. Concerning functional outcome, no residual nasal obstruction was found in all patients with negative Cottle sign postoperative.
Conclusion:
Intracorporeal correction of septal deformities in open rhinoplasty technique is still found to be effective and less invasive option even with sever septal deviation.]]>Thu, 01 Nov 2018 00:00:00 GMT-05:0000001665-201811000-00012https://journals.lww.com/jcraniofacialsurgery/Fulltext/2012/09000/Influence_of_Loading_and_Use_of_Occlusal_Splint_in.136.aspx
Abstract
The aim of the study was to assess the tensions generated in the long axis of the implants and the interimplants in the cervical, middle, and apical regions when subjected to different loads with or without interposition of the flat occlusal plane splint. A photoelastic model was made with 2 external hexagon implants located in the space corresponding to the second premolar and molar inferiors. A screw-retained metal superstructure was installed on the implants with a torque of 20 N·cm, and the set (photoelastic model with superstructure) were positioned in the circular polariscope in the dark-field configuration to observe the distribution of isochromatic fringes around the implants and interimplant areas. Photographic records were obtained before the application of the occlusal load with the following loading conditions: 300, 600, and 900 N, with and without interposition of the occlusal plane splint. The decrease in stress with the application of the flat occlusal plane splint became more evident after the application of the 600-N load. Generally, the major stress magnitude occurred in the cervical region for interimplant areas and in the apical region around implants. Use of occlusal splint in the loading of 300, 600, and 900 N reduced tension 33.22%, 66.66%, and 73.33%, respectively, in the samples. It can be concluded that the interposition of the occlusal plane splint caused a reduction in tension resulting from the simulation of occlusal overload.]]>Sat, 01 Sep 2012 00:00:00 GMT-05:0000001665-201209000-00136https://journals.lww.com/jcraniofacialsurgery/Fulltext/2005/09000/Congenital_Smooth_Muscle_Hamartoma__The_Importance.37.aspx
Congenital smooth muscle hamartoma (CSMH) is a rare cutaneous lesion commonly seen on the trunk or extremities as a localized skin-colored or mildly hyperpigmented and irregularly shaped patch or plaque with prominent vellus hairs. Histologically, CSMH is characterized by the proliferation of intersecting bundles of smooth muscle. The clinical differential diagnosis of CSMH includes congenital melanocytic (pigmented) nevus, Becker's melanosis, solitary mastocytoma, piloleiomyoma, café-au-lait spots, and nevus pilosus. Differentiating CSMH from a congenital melanocytic nevus avoids the unnecessary excision of this benign condition.]]>Thu, 01 Sep 2005 00:00:00 GMT-05:0000001665-200509000-00037https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/06000/Organ_on_a_Chip___New_Tool_for_Personalized.6.aspx
No abstract available]]>Fri, 01 Jun 2018 00:00:00 GMT-05:0000001665-201806000-00006https://journals.lww.com/jcraniofacialsurgery/Fulltext/2007/05000/Easy_Facial_Analysis_Using_the_Facial_Golden_Mask.30.aspx
For over 2000 years, many artists and scientists have tried to understand or quantify the form of the perfect, ideal, or most beautiful face both in art and in vivo (life). A mathematical relationship has been consistently and repeatedly reported to be present in beautiful things. This particular relationship is the golden ratio. It is a mathematical ratio of 1.618:1 that seems to appear recurrently in beautiful things in nature as well as in other things that are seen as beautiful. Dr. Marquardt made the facial golden mask that contains and includes all of the one-dimensional and two-dimensional geometric golden elements formed from the golden ratio. The purpose of this study is to evaluate the usefulness of the golden facial mask.
In 40 cases, the authors applied the facial golden mask to preoperative and postoperative photographs and scored each photograph on a 1 to 5 scale from the perspective of their personal aesthetic views.
The score was lower when the facial deformity was severe, whereas it was higher when the face was attractive. Compared with the average scores of facial mask applied photographs and nonapplied photographs using a nonparametric test, statistical significance was not reached (P > 0.05). This implies that the facial golden mask may be used as an analytical tool.
The facial golden mask is easy to apply, inexpensive, and relatively objective. Therefore, the authors introduce it as a useful facial analysis.]]>Tue, 01 May 2007 00:00:00 GMT-05:0000001665-200705000-00030https://journals.lww.com/jcraniofacialsurgery/Fulltext/2004/01000/Molding_Helmet_Therapy_in_the_Treatment_of.31.aspx
The purpose of this study was to compare the use of molding helmet therapy in the treatment of positional brachycephaly and posterior positional plagiocephaly. Four hundred twenty-eight children with positional brachycephaly or plagiocephaly were included in this study. In this group of patients, 132 (32%) were treated with positioning alone. Of the 292 (68%) patients who were treated with molding therapy, 64 (21.9%) were treated for positional brachycephaly and 248 (78.1%) were treated for posterior positional plagiocephaly. All children were evaluated by a craniofacial surgeon and a pediatric neurosurgeon. Anthropomorphic measurements were used to assess the efficacy of treatment. Measurements were made before initiation of therapy and at 2-month intervals until the completion of therapy. Results showed that statistically significant improvements (P < 0.01) were seen in all patients treated with molding helmet therapy. Overall, the children with posterior plagiocephaly normalized their head shapes; however, the head shapes of the children with positional brachycephaly did not normalize despite statistically significant improvements in their Cephalic Index. It is concluded that molding helmet therapy is an effective treatment of position-induced head shape abnormalities. Helmet therapy is more effective in children with posterior positional plagiocephaly than in children with positional brachycephaly.]]>Thu, 01 Jan 2004 00:00:00 GMT-06:0000001665-200401000-00031https://journals.lww.com/jcraniofacialsurgery/Fulltext/2017/05000/Long_Term_Outcome_of_Microautologous_Fat.13.aspx
Objective:
Sunken temporal fossa appears oftentimes in Asians and resembles bad fortune that people wish to change. Numerous techniques and materials have been applied clinically for augmenting the sunken temporal fossa with variable results. The microautologous fat transplantation (MAFT) technique proposed by Lin et al in 2006 has demonstrated favorable results in facial rejuvenation. In the present study, the authors applied the MAFT technique with an innovative instrument in sunken temporal fossa and reported its results.
Methods:
Microautologous fat transplantation was performed on 208 patients during the 4-year period starting in January 2010. Fat was harvested by liposuction, processed and refined by centrifugation at 1200 g for 3 minutes. Then purified fat was microtransplanted to the temporal fossa with the assistance of an instrument, MAFT-Gun. The patients were followed up regularly and photographs were taken for comparison.
Results:
On average, the MAFT procedure took 48 minutes to complete. The average delivered fat was 6.8 ± 0.2 mL/6.5 ± 0.3 mL for the right/left side. The average follow-up period was 18 months. No complication including skin necrosis, vascular compromise, nodulation, fibrosis, and asymmetry was noted. The patient-rated satisfaction 5-point Likert scale demonstrated that 81.3% of all patients had favorable results (38.5% very satisfied and 42.8% satisfied).
Conclusions:
The concept and technique of MAFT along with the micro- and precise controlling instrument enabled surgeons to perform fat grafting accurately and consistently. In comparison with other strategies for volume restoration, the MAFT procedure demonstrated the patients’ high satisfaction with the long-term results. Therefore, the potential of MAFT as an alternative strategy in sunken temporal fossa in Asians was emphasized.]]>Mon, 01 May 2017 00:00:00 GMT-05:0000001665-201705000-00013https://journals.lww.com/jcraniofacialsurgery/Fulltext/2017/01000/Nasal_Airway_Evaluation_After_Le_Fort_I_Osteotomy.47.aspx
Septal deviation constitutes an important component of both esthetic deformity and airway compromise in patients with cleft lip and palate (CLP). The posterior parts of the nasal septum presented greater deviation than the anterior parts in patients with complete unilateral CLP. Le Fort I down-fracture provides better access to the nasal septum than intranasal incision during rhinoplasty, especially to the posterior part. This study objectively and subjectively evaluated the nasal function after Le Fort I osteotomy combined with septoplasty in patients with complete unilateral CLP. Twenty-three patients with complete unilateral CLP presenting with nasal obstruction and septum deviation were included (12—combined surgery group; 11—control group). Types of septum deviation in the patients were analyzed. Presurgical and 6-month-postsurgical acoustic rhinometry (AR) was performed for objective assessment; and the nasal obstruction symptom evaluation (NOSE) scale was used for subjective assessment. The authors used SPSS to compare the baseline and follow-up results. Acoustic rhinometry assessment showed improvements in the nasal minimal cross-sectional area (MCA), nasal resistance, and nasal volumes in 12 patients who received combined surgery. For the 2 groups, significant improvements in nasal breathing were documented (by NOSE scores) at 6 months after surgery. Simultaneous management of the maxillary dysplasia (Le Fort I osteotomy) and intranasal pathology (septoplasty) were effective for relief of nasal airway obstruction in patients with complete unilateral CLP. The combination of objective (AR) and subjective (NOSE scale) assessments allowed better evaluation of the nasal function.]]>Sun, 01 Jan 2017 00:00:00 GMT-06:0000001665-201701000-00047https://journals.lww.com/jcraniofacialsurgery/Fulltext/2018/01000/Bony_Changes_in_a_Unilateral_Maxillary_Sinus.78.aspx
Objectives:
In the paranasal sinus fungal ball (SFB), changes that occur in the underlying bone have not been well described. Recently, bacterial coinfection has been reported in patients with paranasal SFB. We evaluated whether bone changes occur in patients with unilateral maxillary SFB, and also how bacteria in an SFB affect the bony wall of the sinus.
Methods:
A retrospective study of patients with a unilateral maxillary SFB undergoing endoscopic sinus surgery was conducted from July 2009 to December 2015. Preoperative computed tomography images of the patients were reviewed. Wall thickness (WT) and wall density (WD) of the diseased sinus were measured and compared to the normal sinus. Specimens of the sinus aspirates were obtained during surgery for aerobic and anaerobic cultures.
Results:
Forty-three patients were included (mean, 55.7 ± 12.8 years). Thirty-one cultures (72.1%) were positive for bacteria. Thickening was evident in the anterior, lateral, and posterior walls of the diseased sinus. The average WT was 1.69 ± 0.45 mm on the diseased sinus and 1.14 ± 0.31 mm on the normal sinus (P Mon, 01 Jan 2018 00:00:00 GMT-06:0000001665-201801000-00078https://journals.lww.com/jcraniofacialsurgery/Fulltext/2001/01000/Abrikossoff_s_Tumor.13.aspx
Abrikossoff's tumor is a disease that more commonly affects the oral cavity but can also occur at other sites. It develops between the second and sixth decades of life, more frequently among women and blacks. The neoplasm can affect all parts of the body. The head and neck areas are affected in 45% to 65% of cases and of these, 70% are located interorally (tongue, oral mucosa, hard palate). The benign form shows polygonal cells with granular, eosinophilic cytoplasm and small nuclei. The malignant form, however, is associated with a high mitotic index and pleomorphic cellular tissue. The clinical aspect of the neoformation is a swelling covered by mucus of normal appearance. Studies of the neoformation show that in addition to the objective examination, further instrumental research is necessary, i.e., with nuclear magnetic resonance or computed tomography with contrast CT scan. However, the only examination that can confirm the clinical diagnosis is the histological examination. The only treatment for Abrikossoff tumor is surgery. The surgical treatment provides for an extirpation of the neoformation with the overhanging mucus and the underlying periosteum. In this work, the authors discuss a case of Abrikossoff tumor affecting the mucus of the right side of the hemipalate in a 53-year-old patient and present a review of the literature.]]>Mon, 01 Jan 2001 00:00:00 GMT-06:0000001665-200101000-00013https://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/The_Evaluation_of_Morphometry_of_the_Mastoid.61.aspx
Abstract
The aim of this study was to examine the relationships of the bony landmarks on the lateral surface of the mastoid process (MP). It was also the target of this study to reveal the importance of sexual dimorphism in terms of the mastoid triangle. Our study was performed on 140 (70 women, 70 men) multidetector computed tomography images obtained from patients who underwent radiologic examination at the Department of Radiology of Meram Medical Faculty, Necmettin Erbakan University. The height of the MP was measured using 2 different ways. The distance between the mastoid apex and the midpoint of the distance of the porion and the mastoid notch was measured (mastoid height 1). Then, the distance between the Frankfurt horizontal plane and the mastoid apex was measured (mastoid height 2). The distances between porion–mastoid notch, porion–mastoid apex, porion-asterion, asterion–mastoid apex, articular tubercle–asterion, articular tubercle–mastoid apex, as well as the right and the left MP were also measured. Finally, the angles between porion–mastoid apex–asterion, mastoid apex–asterion– porion, and asterion–porion–mastoid apex were measured. All data were analyzed statistically using the Student’s t-test. According to the results of the measurements, all right and left parameters of the men were higher than the women’s right and left sides except for the angle between asterion–porion–mastoid apex. In addition, all right and left parameters were almost the same in both sexes. Having the knowledge of measurements of the distances between the major landmarks of the temporal bone is essential to avoid possible complications during facial, mastoid, and especially sigmoid sinus surgeries.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00061https://journals.lww.com/jcraniofacialsurgery/Fulltext/2017/11000/Dentoalveolar_Effects_of_Early_Orthodontic.29.aspx
Abstract
No agreement exists on the most appropriate timing of orthodontic treatment in patients with cleft lip and palate. The aim of this study is to investigate the effect of early orthodontic treatment on development of the dental arches and alveolar bone.
A dental casts analysis was performed on 28 children with cleft lip and palate before orthodontic treatment (T0; mean age, 6.5 ± 1.7) and at the end of active treatment (T1; mean age, 9.2 ± 2.1 years). The considered variables were: intercanine and intermolar distances; dental arch relationships, evaluated according to the modified Huddart/Bodenham system.
The study group was divided into 2 samples according to the age at T0: Group A (age < 6 years) and Group B (age ≥ 6 years). A statistical comparison of the treatment effects between the 2 samples was performed.
Patients in Group A exhibited a greater increase of intercanine distance (8 mm versus 2.7 mm; P<0.001), intermolar distance (7.2 mm versus 5 mm; P = 0.06), and Huddart/Bodenham score (7.1 versus 3; P Wed, 01 Nov 2017 00:00:00 GMT-05:0000001665-201711000-00029https://journals.lww.com/jcraniofacialsurgery/Fulltext/2003/09000/Otoplasty__Evaluation,_Technique,_and_Review.8.aspx
Prominent ear deformity is the most common abnormality of the external ear. Over two hundred different techniques have been described to correct this deformity. Many of these techniques have proven successful in their ability to achieve high patient satisfaction despite the significant variations in these techniques. From this perspective otoplasty is a privileged procedure allowing the surgeon great latitude in his approach and ability to achieve patient satisfaction. Despite high patient satisfaction, each technique has inherent strengths and weaknesses. The art of otoplasty is in the ability to realize the strengths and weaknesses of a cadre of procedures so as to maximize benefit and minimize complication.
Analysis and correction of prominent ears should be approached in a rational, step-wise fashion. The external ear is an infinitely complex structure with great variation between individuals and between the two sides of the same individual. Appropriate evaluation is essential to the application of the appropriate corrective technique. Our approach to otoplasty includes a careful evaluation and description of the deformity in the context of normative standards and the goal of symmetry. When the patient is judged to be sufficiently mature we proceed with an algorithmic application of cartilage-sparing techniques suited to the specific deformity. In this approach, correction of the prominent ear can go beyond patient satisfaction, maximizing outcome in form and symmetry.]]>Mon, 01 Sep 2003 00:00:00 GMT-05:0000001665-200309000-00008https://journals.lww.com/jcraniofacialsurgery/Fulltext/2006/05000/LeFort_III_Advancement_with_and_without.25.aspx
The LeFort III osteotomy is the surgical treatment performed in patients with mid-facial retrusions in craniofacial dysostoses such as Crouzon, Apert, Pfeiffer syndromes, etc. The first authors to report the accomplishment of this osteotomy were Gillies and Harrison8 in 1951, this technique was then resumed and improved by Tessier in 19671, who made five different variants mainly regarding the typology of the osteotomy concerning the lateral wall of the orbit. Recently, distraction techniques have been applied to the upper mid-face which foresees a gradual advancement of the mid-face through the osteogenetic distraction procedure. The purpose of this retrospective clinical outcome study is to evaluate and compare the two different surgical techniques through the experience acquired during the treatment of 15 cases of craniofacial dysostoses from 1990-2005, and through international literature. The standard surgery technique was performed in 5 of these patients, whereas the osteogenetic distraction technique was performed in the remaining 10. All patients were studied preoperatively through the acquisition of photographic images, cephalometric analysis of the skull, and the study on plaster models of the occlusion of the dental arches. The instrumental exams required before surgery are the following: telecranium X-rays in two projections, orthopanoramic X-rays, CT. The results of this study indicate that the osteodistraction technique represents the choice treatment in severe retrusions of the mid-face while the traditional surgical technique remains indicated in adult patients that are in need of moderate advancements.]]>Mon, 01 May 2006 00:00:00 GMT-05:0000001665-200605000-00025https://journals.lww.com/jcraniofacialsurgery/Fulltext/2013/07000/Reconstruction_of_Central_Upper_Lip_Defects_With.130.aspx
Abstract
Defects in the central upper lip are difficult to close because of the unique anatomy and limited reconstructive options. Therefore, for every individual patient, reconstructive goals must be prioritized. Reconstructive priorities for an old patient with a large full-thickness oncologic defect are clearly different than those of a teenager with a residual deficiency after cleft repair. Authors aim to share their experience of 2 cases in which large central upper lip oncologic defects have been reconstructed in a single stage using subcutaneous pedicled nasolabial island flap, which provides a single-stage reconstruction by recruiting tissue from the cheek. It obsoletes the need for a lip adhesion. Lip adhesion–related feeding problems are eliminated, oral aperture circumference is maintained, and oral function is preserved. For the elderly male, a full beard is an advantage because it hides both the cheek and the lip scars.]]>Mon, 01 Jul 2013 00:00:00 GMT-05:0000001665-201307000-00130https://journals.lww.com/jcraniofacialsurgery/Fulltext/2012/01000/Computer_Aided_Design_and_Manufacturing_in.68.aspx
Abstract
The goal of this article was to illustrate the ease in which virtual surgery and computer-aided design and manufacturing can be used by the craniomaxillofacial surgeon to create tremendously accurate postoperative results and provide confidence with even the most complex three-dimensional bony reconstructions. With advancements in software technology and three-dimensional printing, our ability to plan and execute precise bony reconstruction has become a reality. With this technology, guides can be made to ensure exact bony repositioning or replacement. These guides can help guide cutting of the bone and can act as splints to precisely reposition the bone and direct plate placement. With use of these computer-aided design and manufacturing guides and the addition of guidance technology, the position of the bone can be guaranteed intraoperatively. We review our unique and advanced method in approaching some of these problems and illustrate the application of these techniques in mandibular reconstruction, orthognathic surgery, maxillofacial trauma, and temporomandibular joint reconstruction. This technology continues to evolve, and our indications for its application continue to grow. This article represents only a small portion of the types of cases in which these techniques have already been applied.]]>Sun, 01 Jan 2012 00:00:00 GMT-06:0000001665-201201000-00068https://journals.lww.com/jcraniofacialsurgery/Fulltext/2010/11000/Tortuous_Internal_Carotid_Artery.107.aspx
No abstract available]]>Mon, 01 Nov 2010 00:00:00 GMT-05:0000001665-201011000-00107